title: 5-Fluorouracil for epithelial downgrowth after Descemet stripping automated endothelial keratoplasty.
abstract: OBJECTIVE
  To report the use of intracameral 5-fluorouracil (5-FU) to treat epithelial downgrowth after performing a Descemet-stripping automated endothelial keratoplasty (DSAEK).
  
  
  METHODS
  We describe the case of a 79-year-old woman who underwent a DSAEK for pseudophakic Fuchs endothelial corneal dystrophy. The patient required 2 repeat DSAEKs for graft failure and persistent, visually significant interface haze. Six months after the third and most recent DSAEK, the patient was followed up and found to have a visual acuity of 20/100. On examination, the patient continued to have a persistent interface haze. However, the patient also had a cellular anterior chamber reaction despite the administration of frequent topical corticosteroids, and subtle findings of a translucent, membranous growth over the iris. Argon laser photocoagulation of the area resulted in a whitening response, characteristic of epithelial growth.
  
  
  RESULTS
  Epithelial downgrowth was diagnosed, and intracameral 5-FU was administered. One month after the injection was given, the patient's examination results and vision improved to 20/60. Six months after the single injection, the patient had a clear DSAEK graft without interface haze, a quiet chamber, and 20/30 visual acuity.
  
  
  CONCLUSIONS
  Epithelial downgrowth that occurs after performing a DSAEK can be treated successfully using intracameral 5-FU.
authors.affiliation: *Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT; and †Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Ryan K
authors.initials: RK
authors.lastname: Wong
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Greene
authors.forename: David R
authors.initials: DR
authors.lastname: Shield
authors.forename: Charles G
authors.initials: CG
authors.lastname: Eberhart
authors.forename: John J
authors.initials: JJ
authors.lastname: Huang
authors.forename: Aryan
authors.initials: A
authors.lastname: Shayegani
mesh_terms: D000368:Aged; D000963:Antimetabolites / Q000627:therapeutic use*; D003316:Corneal Diseases / Q000188:drug therapy* / Q000209:etiology; D057111:Descemet Stripping Endothelial Keratoplasty / Q000009:adverse effects*; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use*; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery; D006801:Humans; D011183:Postoperative Complications / Q000188:drug therapy*; D012086:Reoperation; D016896:Treatment Outcome
chemical_list: D000963:Antimetabolites; D005472:Fluorouracil